Acupuncture in cancer pain

The findings of systematic reviews (SRs) of acupuncture and other acupoint-stimulation techniques for cancer-related pain published in the last 5 years (2021 to Jan 2026) have been summarized below. The full description of the SRs can be found in table 1. 

General characteristics of included studies

Various cancer types: Nine systematic reviews with a wide range of included RCTs depending on language restrictions or acupuncture modality (between 3 and 111 RCTs); various cancer types, stages, and settings.

Specific cancer types: Seven SRs, breast (n=2), lung (n=2), stomach (n=1), liver (n=1), and bone (n=1), including 10-17 RCTs. 

Aromatase inhibitor–induced arthralgia (AIA): Three SRs on aromatase inhibitor–induced arthralgia (AIA) in breast cancer. With four to seven RCTs overlapping across SRs; adult women with hormone‑receptor–positive (ER/PR+) stage I–III breast cancer receiving adjuvant aromatase inhibitors, most often postmenopausal.

Postoperative pain: Two SRs including nine and five RCTs in gastrointestinal or breast surgery. 

Methodological quality and limitations of the evidence

GRADE assessment / certainty: if assessed, overall certainty of evidence is low. High heterogeneity and unclear RoB reduce confidence in pooled estimates.

Systematic reviews: overall quality assessed by AMSTAR2 and judged as low or critically low, few SRs assessed as moderate quality. Frequent issues included no protocol registration, RoB not integrated into interpretation, no publication bias discussion.

Primary RCTs included in the SRs were at high or unclear risk of bias due to frequent lack of blinding (participants, personnel, outcome assessors) and unclear allocation concealment.

Further common limitations: small sample sizes and high heterogeneity. Publication bias suspected in several SRs. Lack of subgroup or sensitivity analyses. Regional concentration of studies (China) limits generalizability of findings. 

Results for efficacy / effectiveness

Various cancer types

For various cancer types, nine systematic reviews reported significant improvements across all SRs for: 

• Pain relief rates (n=4), pain intensity (n=7), pain severity(n=1), clinical efficacy (n=1). 
• Acupuncture vs sham/usual care: SMD ≈ −1.10 to −1.16 (p < 0.00001).
• Electroacupuncture: MD ≈ −1.19 to −1.42 (p < 0.001).
• Acupuncture + WHO ladder: RR for pain relief ≈ 1.12 (95% CI 1.08–1.17, p < 0.00001).
• Wrist–ankle acupuncture + drugs: RR ≈ 1.55 (95% CI 1.26–1.91, p = 0.01).
• Pain intensity reductions: MD range −1.19 to −1.83; SMD range −0.80 to −1.38.
• Response rates: RR up to 4.08 for global improvement (p < 0.001).

Specific cancer types

Consistently reported improvements when compared with no additional treatment or usual care but not compared with sham or placebo acupuncture (2 SRs). 

• Breast cancer; pain intensity: SMD −0.64 (95% CI −1.23, −0.06) P=0.03; pain reduction SMD = -0.83, 95% CI (-1.16, -0.51) but no significant effects when compared with sham acupuncture. 
• Lung cancer, Pain intensity: SMD −1.69 (95% CI −2.49, −0.90), P<0.0001; MD −0.74, 95% CI (−1.08, −0.40), P<0.0001
  Stomach cancer, pain reduction (NRS score): SMD −1.30, 95% CI (−1.96, −0.63), P<0.00; 
• Significant efficacy rate: RR = 1.63, 95% CI (1.37, 1.94), P<0.0000.
• Bone cancer, pain intensity: MD −1.34 (95% CI −1.74, −0.94), P<0.01
• Liver cancer, pain relief: SMD 1.29 (95% CI 1.17, 1.43), P<0.00001

Aromatase inhibitor–induced arthralgia 

Improved pain intensity but mixed result for severity and interference.

• Pain intensity: reduction of worst pain consistent across all 3 reviews when compared with inactive/usual‑care controls. Less consistent when compared with sham acupuncture. 
• Pain severity: no consistently significant results from 2 reviews for interference and WOMAC pain/stiffness/function. 

Postoperative pain

Two SRs reported improved pain outcomes:

• Pain intensity after gastrointestinal surgery: SMD -0.60, 95% CI (-0.83, -0.37), P<0.001; TENS: significant beneficial effect on post-operative pain in one SR.

References

Various cancers

Dai L, Liu Y, Ji G, Xu Y. Acupuncture and derived therapies for pain in palliative cancer management: Systematic review and meta-analysis based on single-arm and controlled trials. J Palliat Med. 2021;24(7):1078–1099. Available from: https://doi.org/10.1089/jpm.2020.0405

Dong B, Lin L, Chen Q, Qi Y, Wang F, Qian K, Tian L. Wrist-ankle acupuncture has a positive effect on cancer pain: A meta-analysis. BMC Complement Med Ther. 2021;21:24. Available from: https://doi.org/10.1186/s12906-020-03193-y

Faria M, Teixeira M, Pinto MJ, Sargento P. Efficacy of acupuncture on cancer pain: A systematic review and meta-analysis. J Integr Med. 2024;22(3):235–244. Available from: https://doi.org/10.1016/j.joim.2024.03.002

Li D, Su Y, Fan H, Guo N, Sun C. Acupuncture combined with three-step analgesic drug therapy for treatment of cancer pain: A systematic review and meta-analysis of randomised clinical trials. Evid Based Complement Alternat Med. 2021;2021:5558590. Available from: https://doi.org/10.1155/2021/5558590

Xie T, Liu C, Wu Y, Li X, Yang Q, Tan J. Efficacy and safety of different acupuncture treatments for cancer-related pain: A systematic review and network meta-analysis. Integr Cancer Ther. 2025;24:1–17. Available from: https://doi.org/10.1177/15347354251314500

Zhang J, Wu W, Ren Y, Yuan Y, Jia L. Electroacupuncture for the treatment of cancer pain: A systematic review and meta-analysis of randomized clinical trials. Front Pain Res. 2023;4:1186506. Available from: https://doi.org/10.3389/fpain.2023.1186506

Zhang Q, Yuan Y, Zhang M, Qiao B, Cui Y, Wang Y, Feng L. Efficacy and safety of acupuncture-point stimulation combined with opioids for moderate to severe cancer pain: A network meta-analysis of randomized controlled trials. Front Oncol. 2023;13:1166580. Available from: https://doi.org/10.3389/fonc.2023.1166580

Specific cancer types

Akutay S, Yüceler Kaçmaz H, Ceyhan Ö. The healing power of transcutaneous electrical nerve stimulation: A systematic review on its effects after breast surgery. Support Care Cancer. 2025;33:90. Available from: https://doi.org/10.1007/s00520-024-09129-3

Chen J, Fu T, Liu L, Xie Y, Li Y. Effect of acupuncture inclusion in enhanced recovery after surgery protocol on tumor patient gastrointestinal function: A systematic review and meta-analysis. Front Oncol. 2023;13:1232754. Available from: https://doi.org/10.3389/fonc.2023.1232754

He Y, Xiang S, Zhang D, Chen M. Acupuncture treatment for liver cancer pain: A meta-analysis. J Surg Oncol. 2024;130(1):83–92. Available from: https://doi.org/10.1002/jso.27691

Jia L, Wang K, Chen S. Acupuncture combined with opioid for treatment of lung cancer-related pain: A systematic review and meta-analysis. Medicine (Baltimore). 2024;103(42):e40158. Available from: https://doi.org/10.1097/MD.0000000000040158

Li H, Schlaeger JM, Jang MK, Lin Y, Park C, Liu T, et al. Acupuncture improves multiple treatment-related symptoms in breast cancer survivors: A systematic review and meta-analysis. J Altern Complement Med. 2021;27(12):1084–1097. Available from: https://doi.org/10.1089/acm.2021.0133

Xi Z, Wei X, Ye Z, Wang K, Zhou J. Acupuncture for adult lung cancer of patient-reported outcomes: A systematic review and meta-analysis. Front Oncol. 2022;12:921151. Available from: https://doi.org/10.3389/fonc.2022.921151

Yan Z, MuRong Z, Huo B, Zhong H, Yi C, Liu M, Liu M. Acupuncture as a complementary therapy for cancer-induced bone pain: A systematic review and meta-analysis. Front Pain Res. 2022;3:925013. Available from: https://doi.org/10.3389/fpain.2022.925013

Zhang Y, Sun Y, Li D, Liu X, Fang C, Yang C, et al. Acupuncture for breast cancer: A systematic review and meta-analysis of patient-reported outcomes. Front Oncol. 2021;11:646315. Available from: https://doi.org/10.3389/fonc.2021.646315

Zhou X, Zhang J, Jiang L, Zhang S, Gu Y, Tang J, et al. Therapeutic efficacy of acupuncture point stimulation for stomach cancer pain: A systematic review and meta-analysis. Front Neurol. 2024;15:1334657. Available from: https://doi.org/10.3389/fneur.2024.1334657

Aromatase inhibitor-induced arthralgia (AIA)

Bae K, Lamoury G, Carroll S, Morgia M, Lim S, Baron-Hay S, et al. Comparison of the clinical effectiveness of treatments for aromatase inhibitor-induced arthralgia in breast cancer patients: A systematic review with network meta-analysis. Crit Rev Oncol Hematol. 2023;181:103898. Available from: https://doi.org/10.1016/j.critrevonc.2022.103898

Liu X, Lu J, Wang G, Chen X, Xv H, Huang J, et al. Acupuncture for arthralgia induced by aromatase inhibitors in patients with breast cancer: A systematic review and meta-analysis. Integr Cancer Ther. 2021;20:1–14. Available from: https://doi.org/10.1177/1534735420980811

Zhu X-Y, Li Z, Chen C, Feng R-L, Cheng B-R, Liu R-Y, et al. Physical therapies for psychosomatic symptoms and quality of life induced by aromatase inhibitors in breast cancer patients: A systematic review and meta-analysis. Front Oncol. 2021;11:745280. Available from: https://doi.org/10.3389/fonc.2021.745280